A Randomized, Controlled Trial on the Efficacy and Safety of Live-Attenuated Influenza Vaccine (LAIV) Among Children in Bangladesh

A Randomized, Double-Blind, Placebo-Controlled Trial on the Clinical Efficacy and Safety of a Single Dose of Trivalent Seasonal Live-Attenuated Influenza Vaccine(LAIV) Among Children Aged 24 Through 59 Months in Bangladesh

This is a single center, multi-site, double-blind, parallel group, placebo-controlled trial of the clinical efficacy of trivalent Serum Institute of India, Ltd. (SIIL)live-attenuated influenza vaccine (LAIV) vaccine among children aged 24 through 59 months in Bangladesh.

Background:

1. Burden: Within Bangladesh, community- based influenza surveillance identified 84.5 cases/1000 children-years among children <5 years, while 10% of clinical pneumonia cases were influenza positive in this age group.
2. Knowledge gap: There has never been a randomized clinical efficacy trial of the SIIL LAIV vaccine conducted among children in a low-income country.
3. Relevance: Another LAIV vaccine (made by MedImmune) has been shown to have high efficacy against laboratory-confirmed influenza among children. The SIIL LAIV has the potential to be an inexpensive intervention to prevent pediatric influenza disease.

Primary Hypothesis: In children aged 24 through 59 months in Bangladesh, LAIV is efficacious in reducing rates of symptomatic, laboratory-confirmed influenza (vaccine-matched strains) among children vaccinated with LAIV as compared to children vaccinated with a placebo through the first influenza season following vaccination.

Primary Objective: To determine the efficacy of LAIV in reducing rates of symptomatic, laboratory-confirmed influenza virus infection (vaccine-matched strains) among children receiving LAIV as compared to children receiving a placebo through the first influenza season following vaccination (through December 2013).

Methods: A total of 1761 children will be enrolled and randomized in a 2:1 ratio of LAIV to placebo beginning in March 2013. After vaccination, all children will be evaluated for reactions with one home visit four days post vaccination. Subsequently, all children will be monitored weekly for safety outcomes and illness signs at weekly field worker home visits through December 2013. An extended surveillance period was added to this study and, for participants consenting to additional follow-up, surveillance will extend through a second season (through September 2014). Participants with illness signs will be referred to the study clinic for evaluation using standardized diagnostic criteria and treatment by a study physician. Children meeting protocol-defined clinical Specimen Collection Criteria will have a nasopharyngeal wash specimen collected. Clinical specimens will be tested by Real time polymerase chain reaction (rRT-PCR) for evidence of influenza virus infection.

Primary Outcome measures/variables: Vaccine efficacy will be assessed against symptomatic, laboratory-confirmed influenza for all circulating virus strains.

Study Overview

• Status: Completed
• Conditions: Influenza
• Intervention / Treatment: Biological: SIIL Live Attenuated Influenza Vaccine; Biological: Placebo

• Study Type: Interventional
• Enrollment (Actual): 1761
• Phase: Phase 3

Contacts and Locations

Study Locations

• Bangladesh
  • Dhaka, Bangladesh
    • icddr, b Kamalapur
  • Matlab, Bangladesh
    • icddr,b Matlab

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 2 years to 4 years (Child)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Healthy male or female child at least 24 months of age and no older than 59 months of age at the time of study vaccination.
• A child whose parent or guardian's primary residence, at the time of study vaccinations, is within the Kamalapur surveillance site catchment area or Matlab service area and who intends to be present in the area for the duration of the trial.
• A child whose parent or legal guardian is willing to provide written informed consent prior to the participant's study vaccination.

Exclusion Criteria:

• Has any serious, active, medical conditions, including: a chronic disease of any body system, chronic infections such as tuberculosis, genetic disorders, such as Down's syndrome or other cytogenetic disorder, known or suspected disease of the immune system.
• Is receiving immunosuppressive agents, including systemic corticosteroids, during the month prior to study vaccination.
• Has a history of documented hypersensitivity to eggs or other components of the vaccine (including gelatin, sorbitol, lactalbumin and chicken protein), or with life-threatening reactions to previous influenza vaccinations.
• Has ever received influenza vaccine (LAIV or inactivated).
• History of Guillain-Barre syndrome
• Is receiving aspirin therapy or aspirin-containing therapy currently or two weeks before.
• Lives in household with somebody currently participating in a respiratory vaccination or antiviral study.
• Has current or past participation (within 2 months of trial enrollment visit) in any clinical trial involving a drug or biologic with activity against respiratory disease.
• History of a previous severe allergic reaction with generalized urticarial, angioedema, or anaphylaxis.
• Has any condition determined by investigator as likely to interfere with evaluation of the vaccine or be a significant potential health risk to the child or make it unlikely that the child would complete the study

Temporary Inclusion Contraindications:

• Concurrent febrile illness (measured temperature 38 degrees C axillary).
• Active wheezing illness

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Placebo	Biological: Placebo; A single dose of inactive placebo will be identical to reconstituted SIIL LAIV in ingredients and concentrations except A/California/7/2009 (H1N1), A/Victoria/361/2011 (H3N2), B/Wisconsin/1/2010 will be replaced with egg allantoic fluid.
Experimental: Vaccine	Biological: SIIL Live Attenuated Influenza Vaccine; A single dose of SIIL Trivalent LAIV--2012/2013 Northern Hemisphere vaccine containing A/California/7/2009 (H1N1), A/Victoria/361/2011 (H3N2), B/Wisconsin/1/2010

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Percentage of Participants With Symptomatic, Laboratory-confirmed Influenza Virus Infection (Vaccine-matched Strains).	Through 7 to 9 months post-vaccination

Secondary Outcome Measures

Outcome Measure	Time Frame
Safety Profile of LAIV: Solicited and Unsolicited Local and Systemic Reactions	Through one week post-vaccination
Safety Profile of LAIV: Immediate Reactions	30 minutes post-vaccination
Safety Profile of LAIV: Serious Adverse Events	Through 7 to 9 months post-vaccination
Safety Profile of LAIV: Protocol Defined Wheezing Illness	Through 7 to 9 months post-vaccination
Percentage of Participants With Symptomatic, Laboratory-confirmed, Influenza Virus Infection (All Strains)	Through 7 to 9 months post-vaccination
The Clinical Characteristics of Influenza, Including Influenza Co-infections With Other Bacterial and Viral Respiratory Pathogens	Through 16 to 19 months post-vaccination
The Viral Etiologies of Acute Respiratory and Febrile Illness	Through 16 to 19 months post-vaccination
Safety Profile of LAIV: Serious Adverse Events	Through 16 to 19 months post-vaccination
Safety Profile of LAIV: Protocol Defined Wheezing Illness	Through 16 to 19 months post-vaccination
Percentage of Participants With Symptomatic, Laboratory-confirmed, Influenza Virus Infection (All Strains)	Through 16 to 19 months post-vaccination
Percentage of Participants With Symptomatic, Laboratory-confirmed Influenza Virus Infection (Vaccine-matched Strains).	Through 16 to 19 months post-vaccination

Other Outcome Measures

Outcome Measure	Time Frame
Percentage of Participants With Moderate to Severe, Laboratory-confirmed Influenza Virus Infection Among Children	Through 7 to 9 months post-vaccination
Percentage of Participants With Moderate to Severe, Laboratory-confirmed Influenza Virus Infection Among Children	Through 16 to 19 months post-vaccination
Percentage of Participants With Symptomatic, Laboratory-confirmed Influenza Virus Infection (Vaccine-matched Strains) Among Children	From approx. 6 months to approximately 19 months post-vaccination
Percentage of Participants With Symptomatic, Laboratory-confirmed Influenza Virus Infection (All Strains) Among Children	From approx. 6 months to approximately 19 months post-vaccination

Collaborators and Investigators

• Sponsor: PATH
• Collaborators: Johns Hopkins University; Bill and Melinda Gates Foundation; Centers for Disease Control and Prevention; International Centre for Diarrhoeal Disease Research, Bangladesh
• Investigators: Principal Investigator: Abdullah Brooks, MD, MPH, Johns Hopkins University

Publications and helpful links

General Publications

• Rotrosen E, Zaman K, Feser J, Ortiz JR, Goswami D, Sharmeen AT, Rahman M, Lewis KDC, Rahman MZ, Barin B, Brooks WA, Neuzil KM. Influenza Among Young Children in Bangladesh: Clinical Characteristics and Outcomes From a Randomized Clinical Trial. Clin Infect Dis. 2017 Nov 13;65(11):1914-1920. doi: 10.1093/cid/cix674.
• Brooks WA, Zaman K, Lewis KD, Ortiz JR, Goswami D, Feser J, Sharmeen AT, Nahar K, Rahman M, Rahman MZ, Barin B, Yunus M, Fry AM, Bresee J, Azim T, Neuzil KM. Efficacy of a Russian-backbone live attenuated influenza vaccine among young children in Bangladesh: a randomised, double-blind, placebo-controlled trial. Lancet Glob Health. 2016 Dec;4(12):e946-e954. doi: 10.1016/S2214-109X(16)30200-5. Epub 2016 Oct 13.

Study record dates

Study Major Dates

• Study Start: February 1, 2013
• Primary Completion (Actual): September 1, 2014
• Study Completion (Actual): September 1, 2014

Study Registration Dates

• First Submitted: February 20, 2013
• First Submitted That Met QC Criteria: February 20, 2013
• First Posted (Estimate): February 22, 2013

Study Record Updates

• Last Update Posted (Estimate): June 11, 2015
• Last Update Submitted That Met QC Criteria: May 15, 2015
• Last Verified: July 1, 2014

More Information

Terms related to this study

• Additional Relevant MeSH Terms: RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Orthomyxoviridae Infections; Influenza, Human
• Other Study ID Numbers: LAIV-CE-01